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WP0042769
EnvironmentalHealth
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ELSHOLZ
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4300 - Water Well Program
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WP0042769
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Last modified
9/19/2022 4:16:55 PM
Creation date
9/19/2022 4:11:41 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4300 - Water Well Program
RECORD_ID
WP0042769
PE
4373
STREET_NUMBER
17093
Direction
E
STREET_NAME
ELSHOLZ
STREET_TYPE
RD
City
RIPON
Zip
95366-
APN
20322004
ENTERED_DATE
12/1/2021 12:00:00 AM
SITE_LOCATION
17093 E ELSHOLZ RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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Borehole Specifications <br />Certification Statement <br />Depth from <br />I, the undersigned, certify that this report is complete and accurate to the best of my knowledge and belief <br />Surface <br />Borehole Diameter (inches) <br />Name MASELLIS DRILLING INC <br />Feet to Feet <br />Person, Firm or Corporation <br />119 ALBERS ROAD MODESTO CA 95357 <br />Address City State Zip <br />Signed electronic signature received 08/15/2022 668622 <br />C-57 Licensed Water Well Contractor Date Signed C-57 License Number <br />DWR Use Only <br />CSG # <br />State Well Number <br />Site Code <br />Local Well Number <br />J_N] W <br />Latitude Deg/Min/Sec Longitude Deg/Min/Sec <br />TRS: <br />APN: <br />Form DWR 188 rev. 12/19/2017 Page 2 of 2 <br />
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